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背景:骨质疏松性胸腰椎骨折目前临床通常采用经皮穿刺椎体成形术治疗,该术式具有操作难度不大,手术时间短,创伤较小,康复快,止痛疗效确切等多项优点,但其存在骨水泥渗漏而引起的神经压迫症状甚至肺栓塞等并发症,制约其发展。如何降低骨水泥的渗漏,是目前研究的热点。目的:分析腰椎QCT值与骨质疏松性胸腰椎骨折伤椎对比剂的弥散分布的关联性。方法:选取60例行经皮穿刺椎体成形术治疗的骨质疏松性胸腰椎骨折患者,术前行腰椎QCT检查,术中往椎体内注射对比剂,正侧位C臂X光机透视,了解不同骨密度值患者对比剂弥散分布情况以及骨水泥在椎体内弥散分布及渗漏等情况,分析腰椎QCT值与伤椎对比剂弥散分布及骨水泥渗漏的关联性。结果与结论:(1)60例共110个伤椎中对比剂弥散超过椎体中线74椎,占67.3%。低骨量组、骨质疏松组、严重骨质疏松组各组间对比剂弥散度比较差异有统计学意义(P<0.05);(2)经单侧或双侧入路椎体成形式注入骨水泥,不同骨密度患者组间骨水泥渗漏情况比较无显著差异(P>0.05)。(3)结果显示,对比剂在骨质疏松性胸腰椎骨折伤椎中的弥散分布与腰椎QCT值有一定关系,QCT值低的患者比QCT值较高的患者伤椎对比剂弥漫分布更充分,但骨水泥渗漏的发生与QCT值高低无明显相关,说明根据QCT值结合对比剂分布选择不同穿刺术式伤椎注入骨水泥可减少其渗漏,提高椎体成形术的安全性。
BACKGROUND: Osteoporotic thoracolumbar fractures are usually treated with percutaneous vertebroplasty clinically at present. The procedure has many advantages such as less difficulty in operation, shorter operation time, less trauma, quick recovery and exact analgesic effect. However, the existence of bone cement leakage caused by nerve compression symptoms and even complications such as pulmonary embolism, restricting its development. How to reduce the leakage of bone cement is the hotspot of current research. OBJECTIVE: To analyze the correlation between the QCT value of lumbar spine and the diffuse distribution of vertebral contrast media in patients with osteoporotic thoracolumbar fractures. Methods: Sixty patients with osteoporotic thoracolumbar fractures treated by percutaneous vertebroplasty were performed preoperative lumbar QCT examination, intraoperative vertebral body injection of contrast medium and posterior c-arm X-ray machine To investigate the diffuse distribution of contrast media and the diffusion and leakage of bone cement in the vertebral body of patients with different BMD values. The correlation between the QCT value of lumbar spine and the diffuse distribution of contrast agent and bone cement leakage was analyzed. RESULTS AND CONCLUSION: (1) Contrast agent in 60 injured vertebrae of 110 injured vertebral bodies diffused more than 74 vertebrae, accounting for 67.3%. There was significant difference of diffusivity of contrast media among the groups with low bone mass, osteoporosis group and severe osteoporosis group (P <0.05). (2) Injecting into the vertebral body by unilateral or bilateral approach There was no significant difference in bone cement leakage between the groups of bone cement and bone mineral density (P> 0.05). (3) The results showed that the diffuse distribution of contrast agent in vertebral vertebral fracture of osteoporotic thoracolumbar fractures is related to the QCT value of lumbar spine. In patients with low QCT value, diffuse distribution of contrast agent in the vertebral column more fully than in patients with higher QCT value , But there was no significant correlation between the occurrence of bone cement leakage and the level of QCT. It is indicated that the injection of different puncture type vertebral vertebral fractures according to QCT value and contrast agent distribution can reduce leakage and improve the safety of vertebroplasty.